Delphi Consensus of the Italian Society of Pediatric Allergy and Immunology (SIAIP) on the management of severe asthma in children and adolescents.

Authors

Michele Miraglia Del Giudice, Gianluigi Marseglia, Sara Manti, Filippo Favuzza, Maria Angela Tosca, Giorgio Ciprandi, Amelia Licari

Published in

Multidisciplinary respiratory medicine. Volume 21. Pages 1095. Jul 20, 2026. Epub Jul 20, 2026.

Abstract

Severe asthma affects approximately 3-5% of the pediatric asthmatic population and is associated with substantial clinical, economic, and psychosocial burdens. Despite major advances in biological therapies, standardized guidance for their optimal use in children and adolescents remains limited.
To establish experts' consensus on the management of severe pediatric asthma through a Delphi process promoted by the Italian Society of Pediatric Allergy and Immunology (SIAIP), with particular focus on biological therapy selection, monitoring, and response assessment.
A modified Delphi process involving 50 pediatric asthma experts was conducted. Twenty-seven statements addressing epidemiology, pathophysiology, biomarkers, biological therapies, monitoring strategies, and response definitions were developed through iterative rounds. Consensus was defined as ≥80% agreement (scores 4-5 on a 5-point Likert scale).
All 27 statements achieved consensus (agreement range: 82-100%; mean scores: 4.1-4.9). Complete consensus was reached on key issues, including the need for endotype-based therapy selection, the predominance of type 2 inflammation in severe pediatric asthma, the role of currently available biological therapies (omalizumab, mepolizumab, dupilumab, tezepelumab), multidimensional response assessment (clinical, functional, and biological), and the importance of patient and family engagement. Strong consensus also supported the use of Core Outcome Measures for Severe Asthma (COMSA) for monitoring, classification of responders/super-responders /non-responders, and the predictive value of selected biomarkers, including blood eosinophil counts (≥300 cells/µL), FeNO, and baseline oral corticosteroid dose.
This Delphi Consensus provides expert-endorsed, evidence-based recommendations for the management of severe pediatric asthma, emphasizing personalized selection of biological therapy guided by biomarkers and systematic response monitoring using standardized outcome measures.

PMID:
42474351
Bibliographic data and abstract were imported from PubMed on 20 Jul 2026.

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